Section 210-RICR-30-00-5.9 - Medicaid Reasonable Compatibility StandardsA. When information obtained through the federal data hub and State data sources is found reasonably compatible with the applicant's attestation, no further verification is required, and the eligibility determination will proceed. The reasonable compatibility standards set forth below by the State are applicable to income verification. The term "data" refers to information obtained through electronic data matches across federal and State sources.B. Overview of Standards Medicaid Reasonable Compatibility Standards for Income |
Attestation and Data Scenario | Reasonable Compatibility Standard |
Attestation and SWICA and UI data are below applicant's Medicaid eligibility levels. | Reasonably Compatible: Person eligible for Medicaid |
Attestation and SWICA and UI data are above applicant's Medicaid eligibility levels. | Reasonably Compatible: Person ineligible for Medicaid; eligibility for a qualified health plan (QHP) is determined |
The attestation is below the applicant's Medicaid eligibility level and the SWICA and UI data are above the applicant's Medicaid eligibility level, and the difference between the attestation and data is ten percent (10%) or less. | Reasonably Compatible: Person eligible for Medicaid |
The attestation is below the applicant's Medicaid eligibility level and the SWICA and UI data are above the applicant's Medicaid eligibility level, and the difference between the attestation and data is greater than ten percent (10%). | Not Reasonably Compatible: pursue discrepancy reconciliation. Person may provide a reasonable explanation and/or provide the State with documentation of current income. |
1. Income attestation and data are both below Medicaid eligibility levels - Attestation and data sources are reasonably compatible if the difference or discrepancy between the two (2) does not affect the eligibility of the applicant. In other words, even if there is a difference between what an applicant says he or she earned and what the data shows was actually earned, the attestation and data are considered reasonably compatible if both are below Medicaid eligibility levels.2. Attestation and data are both above Medicaid eligibility levels - Attestation and data sources are reasonably compatible if they are both above the Medicaid eligibility levels. Under such a scenario, the person would be found ineligible for Medicaid. For example, this would occur if an applicant attests to income above the eligibility ceiling for the applicable MACC group and electronic data-based verification indicates that the applicant's income is higher than that amount. The applicant is not eligible for Medicaid in either case. Eligibility for affordable care with federal advance premium tax credits and cost-sharing reductions is then reviewed.3. Income attestation - The difference between the income attestation and the data is less than ten percent (10%) - An income attestation and data from electronic sources are considered reasonably compatible if the difference between the applicant's attestation and the data sources is less than ten percent (10%). The applicant is eligible, provided all other eligibility criteria are met.4. Income attestation - The difference between the income attestation and data sources is greater than ten percent (10%). An income attestation and data on income sources are considered to be not reasonably compatible if the difference between the applicant's attestation and data sources is greater than ten percent (10%); a reasonable explanation is pursued.210 R.I. Code R. 210-RICR-30-00-5.9
Amended effective 8/25/2020
Amended effective 10/1/2024